IVF is not a particularly painful procedure. The most painful part of IVF is the injections. There are 1-2 injections per day for 10-12 days during oocyte stimulation. With recent advances, this too has been made more comfortable for the patients.

IVF stands for In Vitro Fertilisation where In Vitro means “outside the body”. Literally, IVF means creating a baby outside the body.

IVF is an advanced fertility treatment. First, you need to understand if it is even required for your conception. The best course of action would be to do a fertility consultation where the doctor can perform basic fertility tests (sonography scan of the wife, semen test of the husband), read previous fertility related reports and give you a fertility assessment. At Jilla IVF, this consultation is free 🙂

IVF process can be broken into:
1. Consultation and deciding treatment: This is pre-treatment step where all investigations are performed, the final treatment and final treatment costs are decided.
2. Stimulation: Starting from the second day of menses, 10 days of hormone injections are given daily in order to grow all the eggs in the wife’s ovaries. At the end of stimulation, a “trigger” injection is given.
3. Oocyte Pick Up: 36 Hours after the trigger injection, eggs are retrieved from the wife’s ovaries in a procedure called Oocyte Pick Up. The husband gives a semen sample on this day too and the eggs and sperms are fertilised in the IVF Lab on this day.
4. Embryo Transfer/Embryo Freezing: 5 days after Oocyte Pick Up, we see that some embryos have grown well for 5 days, while other embryos’ growth has been suspended. This is a form of natural selection where the strongest embryo survives and grows while the weaker embryos’ growth stops. It is only the good growing day 5 embryo that we transfer back into the wife’s uterus, the other embryos get discarded. At this stage, either the good embryos are transferred, or they are frozen in order to transfer at a later date. Read “When are embryos frozen?”
5. Result Day: 14 days after embryo transfer, we can do a Beta HCG blood test to check if a pregnancy has resulted. A value above 100 indicates that it has!
6. Further Counselling: In either case – pregnancy or not, further counselling will inform us about the next steps for us. In case of an IVF failure, two things are important. One, that we do not lose hope. IVF is not a complete science yet and results are not guaranteed. There is always some chance of failure. Two, we must critically learn from our IVF cycle. Lots of things in an IVF cycle happen for the first time. We see eggs under a microscope for the first time, we see the growth of the embryo for 5 days in our lab, we understand embryo implantation after doing a transfer. All of these give us a better understanding of which exact step is failing and how we can do better. A further plan for treatment should be discussed with the patient.

An IVF cycle starts from the 2nd of menses and ends around the 20th day. It takes 18 days on average assuming that embryo transfer is done in the same cycle. In some cases, we may freeze embryos and transfer them in a later month. Read “Why/when to freeze embryos?” to learn more about embryo freezing. In these cases, the time taken is the number of months we wait before we transfer the embryo back.

Embryo freezing or cryopreservation is done to preserve the embryo for later transfer. We may want to do this in a few cases –
1. Thin Endometrium: If the lining of the uterus (endometrium) is not prepared to the required thickness (more than 8mm), it will not be able to support the embryo. So, we should wait until we are able to grow the endometrium to the required thickness. Read “Thin Endometrium” to understand more.
2. PCOS/Large Number Of Eggs: For patients with large number of eggs (more than 20), the effect of having a lot of eggs, hormone injections given during stimulation, and a possible pregnancy from the result of embryo transfer, can increase the hormone level so much that there is a risk of Ovarian Hyperstimulation. This is a serious condition wherein the patient may need to be shifted to an intensive care unit. So, when there are a large number of eggs, it is safer to preserve the eggs in the first cycle, and transfer them in the next cycle to make sure the hormone levels do not rise too high and that we are safe from Ovarian Hypterstimulation. We follow this as a policy at Jilla IVF and our clinic has been Ovarian Hyperstimulation free for many years now!
3. Infection: Sometimes, the uterus may be infected (for example, with Tuberculosis or Chlamydia). This infection will not allow the embryo to survive so we first complete a dose of antibiotics to suppress the infection, and transfer.
4. Fertility Preservation: The beauty of freezing or cryopreservation is that it preserves the age of the embryo. For example, an embryo made from a 30 year old female’s eggs and a 32 year old man’s sperms will have the same age even when it is used 8 years later when the female is 38 years old and the man is 40. This is important because if the couple was to try at the ages of 38 and 40, their fertility potential will have vastly reduced because of their age. The frozen embryos help preserve their fertility for later use.